产前糖皮质激素在早产中的应用(3)
[4]。
2.对胎儿的影响
产前应用糖皮质激素能够降低早产儿RDS、IVH的发生率和死亡率,也降低了早产引起的其他并发症,包括NEC、PDA和BPD。长期随访证实,孕期暴露于单剂量糖皮质激素的婴儿远期身体状况和精神心理方面没有差异[9]。虽然倍他米松和地塞米松均可降低早产儿并发症和死亡率,倍他米松可能优于地塞米松。
三、总结
产前糖皮质激素的应用对改善围产儿结局有明显的作用,其使用的时机很重要。理想情况下,出生前一周内进行单疗程糖皮质激素治疗,但由于预测早产临产时间困难,许多胎儿都在不经意间过早暴露于产前糖皮质激素,而未在获益最大时使用。对于接受产前糖皮质激素但最终足月分娩的新生儿也已引起了人们的关注,因此,临床医生面临的一个重大挑战,即对接下来一周内可能早产分娩的小于34周的孕妇,仅使用一个完整疗程的产前糖皮质激素而使胎儿获益。
参考文献
[1] Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972 Oct;50(4):515-25.
[2] Bonanno C, Wapner RJ. Antenatal corticosteroid treatment: what's happened since Drs Liggins and Howie? Am J Obstet Gynecol 2009; 200:448.
[3] Polk DH, Ikegami M, Jobe AH, et al. Preterm lung function after retreatment with antenatal betamethasone in preterm lambs. Am J Obstet Gynecol 1997; 176:308.
[4] Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3:CD004454.
[5] Raju TN, Mercer BM, Burchfield DJ, Joseph GF Jr. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2014; 210:406.
[6]Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Am J Obstet Gynecol. 2016 Aug;215(2):B13-5.
[7] Hashima JN, Lai Y, Wapner RJ, et al. The effect of maternal body mass index on neonatal outcome in women receiving a single course of antenatal corticosteroids. Am J Obstet Gynecol 2010; 202:263.e1.
[8] 中华医学会妇产科学分会产科学组《早产临床诊断与治疗指南(2014)》, 中华妇产科杂志 2014 年第七期
[9] Crowther CA, McKinlay CJD, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: : 10.1002/.CD003935.
[10] Gurbuz A, Karateke A, Ozturk G, Kabaca C. Is 1-hour glucose screening test reliable after a short-term administration of antenatal betamethasone? Am J Perinatol 2004; 21:415.
[11] Vaisbuch E, Levy R, Hagay Z. The effect of betamethasone administration to pregnant women on maternal serum indicators of infection. J Perinat Med 2002; 30:287.
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